Evaluation of proteinuria and GFR to diagnose and classify kidney disease: systematic review and proof of concept.

Chronic kidney disease is often not associated with significant symptoms or abnormalities in common laboratory test results. Diagnosis is supposedly facilitated by calculating the glomerular filtration rate (GFR) from serum creatinine. A reference range GFR, however, does not exclude renal disease, because renal disease causes the subsequent decrease of renal function.

[Life threatening hypercalcemia in a young man with ALL].

History And Admission Findings: A 16-year-old man experienced fatigue, vomiting and diffuse abdominal pain. Since 4 days he had myalgia in both arms and legs. On examination only a tachycardia of 110/min was noticed.

Continuous haemofiltration with r-hirudin (lepirudin) as anticoagulant in a patient with heparin induced thrombocytopenia (HIT II).

A 60-year-old man was admitted to the hospital with aortic dissection. An operative excision and replacement with a Y-graft was performed. Postoperatively he developed multiple organ dysfunction and required intermittent haemofiltration (anticoagulation with heparin).

High-dose torasemide, given once daily intravenously for one week, in patients with advanced chronic renal failure.

Effects, both acute and after repeated dosing of 200 mg of intravenous torasemide in comparison to baseline values on placebo, were investigated with respect to 24 h fractional volume excretion and electrolyte excretion, signs of peripheral edema and changes in body weight in the present open uncontrolled multicenter study. Fourty-four patients with advanced chronic renal failure (mean creatinine clearance 8.9 +/- 9.

Observations on renal replacement services in Russia, Belarus and Lithuania.

This report describes the current financial, technical and medical status of nephrology, dialysis and renal transplant services in these countries with the hope of helping our colleagues there to upgrade their standards of care. The general impression is that physicians as well as administrators in these countries are eager to improve conditions of patient care despite a disastrous economical climate. Our view is that we can help by providing literature, textbooks, journals, travel funds, by offering visiting fellowships to individual physicians, and by forming partnerships between nephrology centres.

Cyclosporine pharmacokinetics and variability from a microemulsion formulation--a multicenter investigation in kidney transplant patients.

The steady-state pharmacokinetics and tolerability of a microemulsion formulation of cyclosporine (Sandimmune Neoral) were compared with the commercial formulation (Sandimmune) in 55 clinically stable renal allograft recipients. In study period I (2 weeks' duration), patients entered the study on a stable, individualized twice-daily dosage regimen of the commercial formulation. In period II (2 weeks), they were changed over to the microemulsion formulation at the same dose as at study entry.

Improved classification of proteinuria by semiautomated ultrathin SDS polyacrylamide gel electrophoresis.

The quantitative and qualitative analysis of proteinuria by electrophoretic means proved to be a potent diagnostic tool for differentiation of functional renal impairment. The purpose of this study was to compare the macro scale SDS-PAGE technique, which has been used for the last two decades, with semiautomated electrophoresis using an ultrathin SDS-PAA gel with silver staining (Phast system). The new system proved to be quick and easy to handle.

[Fractional clearance of beta-2-microglobulin in the diagnostic and prognostic assessment of kidney diseases].

The micromolecular proteinuria (67-11 Kd), originating from tubulo-interstitial disorders, might be determined by SDS- or gradient-PAGE or by individual marker proteins. The latter procedure in addition to PAGE is necessary in case of heavy proteinurias. The tubular resorptive capacity for microproteins, analysed by fractional beta-2-M-clearances, decreases with deteriorating GFR.

Plasma exchange and immunosuppression in rapidly progressive glomerulonephritis: a controlled, multi-center study.

In a randomized study of 26 patients with histologically confirmed rapidly progressive crescentic glomerulonephritis, 12 patients were treated with immunosuppressants alone (corticosteroids, cyclophosphamide and azathioprine) while the other 14 patients received not only the identical immunosuppressive treatment but also plasma exchange therapy for four weeks. No statistically significant difference was found between the two groups. After 8 weeks, 73% and 69% of the patients in each respective group showed recompensation of renal function; serum creatinine fell from initially 7.

Mild proteinuria in patients with unilateral kidney.

Arterial blood pressure, 24 h urinary excretion, and glomerular filtration rate (GFR) in 24 patients with unilateral kidney were compared with an age and sex matched control group of healthy persons. Of the patients with unilateral kidney, 13 were uninephrectomized and 11 patients had a congenital unilateral kidney. The 24 h urinary protein excretion in patients with one kidney was significantly higher (630 +/- 51 mg/24 h) compared to the control group (206 +/- 36 mg/24 h).

[Does febrile proteinuria exist?].

The significance of proteinuria during febrile infectious diseases is widely underestimated, although the more marked proteinuria probably signalizes a parainfectious nephropathy rather than a functional disorder. This study shows that mild proteinuria of less than 0.65 g/24 h (normal range less than 0.

Urinary protein patterns and preeclampsia.

A retrospective study of urinary protein patterns, as determined by SDS-PAA-disc-electrophoresis was performed in 107 patients in third trimester of pregnancy because of preeclampsia. The aim was to determine whether the protein patterns allow a differentiation between nephropathies associated with genuine toxaemia of pregnancy and those in which toxaemia was superimposed on preexisting renal glomerular or tubular disease. The magnitude and type of proteinuria was related to the mean arterial pressure (MAP).

[Results of continuous permanent irrigation in diffuse purulent peritonitis].

In a prospective study continuous peritoneal lavage was carried out in 30 patients with diffuse purulent or fecal peritonitis using a volume of 20-50 1/24 h during 5-7 days. Bacteria were recognised in the effusate until day 5. Protein losses per 24 hours amounted to 4,1-46 g.

Diagnostic significance of SDS-PAA-electrophoresis of urinary proteins: different forms of proteinuria and their correlation to renal diseases.

Different types of urinary protein excretion may be recognized by determination of the proteins molecular weight. Beside chromatography different electrophoretic procedures have been applied to urinary proteins to study the underlying renal disease. The various zone electrophoreses separate merely by surface charge, proteins however covered by sodium dodecyl sulfate (SDS) migrate according to their molecular radius.

Studies on excretion of renal antigens in normal and pathological urine.

The report deals with attempts to identify and quantitate renal antigens excreted into the urine of normal subjects and patients with renal disease. Although no useful information was obtained on the possible excretion of glomerular basement membrane antigens, renal tubular epithelial antigen (RTE) proved to be interesting. Curiously, massive excretion of RTE occurred most prominently in cases of 'minimal change' disease.

Polymeric albumin in the urine of patients with nephrotic syndrome.

Dimer and polymer albumin was detected in the urine of a proportion of pantients with a nephrotic syndrome. Most of it was present as S-S bonded dimer and polymer; co-polymers, however, with IgG and alpha (1) anti-trypsin could be demonstrated. It is suggested that albumin polymerizes after it has passed the glomerular membrane.